April 1, 2014

Providing Effective Feedback

One of the toughest yet crucial aspects
of being an instructor is providing effective and constructive feedback.Whether you are inside or outside the
classroom teaching, you will have the responsibility of providing feedback both
praise and constructive at some point in your career.Although it may be uncomfortable for some,
there are many techniques to assist you with providing verbal and written
feedback to a learner. Personally, as a Doctor
of Pharmacy student and now a resident, providing written and verbal feedback
to preceptors or pharmacy students has been a struggle. Like others, I am always afraid of hurting someone’s
feelings. I believe the key to effective
feedback is the timing and the environment in which the feedback is delivered.

Feedback is defined as information provided by an agent (teacher,
peer, parent, self, or experience) regarding aspects of one’s performance, thus
it is a consequence of performance.1 Feedback should be structured
to fill the gap between what is understood and what is expected of the
learner.Structured methods for
providing feedback date back to the early 1900s when behaviorism was developed.In behaviorist terms, “positive feedback” is positive
reinforcement and “negative feedback” is punishment.Although feedback is powerful, it is not
always accepted.Feedback can be
accepted, modified, or rejected by the learner thus it does not necessarily
reinforce actions despite behaviorist’s initial theories on how feedback shaped
behavior.Feedback methods vary based on
timing, amount, mode, audience, and its content.Furthermore, the content varies based on
focus, comparison, function, valence, clarity, specificity, and tone (Table 1).1

Table 1 - Feedback Strategies and Content

Feedback
Strategy

Aspects

Recommendations

Timing

-When

-How
often

-Where

Provide
immediate feedback for incorrect facts

Reserve
criticism for appropriate timing and when there is privacy

Suggest
a different location other than your office to make learner more comfortable.

Amount

-Number
of points to make

-Elaboration

Prioritize: No
more than 2 “lessons” in one session

The
smaller and more frequent, the better

Mode

-Verbal

-Written

-Electronic

In-person
discussions are best to allow a conversation and to ensure understanding

Electronic
can be interpreted differently than intended. Use this with short
remarks only

Audience

-Individual

-Group/Class

Focused
attention is best- avoids embarrassment

Share
the feedback if common among learners but be careful about “picking on”
one person

Feedback
Content

Aspects

Recommendations

Focus

-Process
used for task

-Work/actions
itself

-Student’s
self-regulation

-Student
personally

Most
effective- focus on the process used for task completion and observed
behavior

Avoid
personal comments because it makes learner get defensive and reject feedback

A comprehensive meta-analysis by Hattie in 2007 evaluated the effect
of providing feedback in the classroom.2 This analysis examined factors that
influence educational achievement such as schooling, homes, students, teachers,
and curricula.A subgroup analysis of
studies evaluating feedback observed an average effect 50% greater than the effect
than schooling itself.Other influences
on achievement in decreasing order of their magnitude of effect include direct
instruction, reciprocal teaching, homework, the use of calculators, and
reducing class size.Most teachers are
comfortable with providing homework and calculators, yet feedback is at least
50% more powerful at influencing the learners’ achievement.Not all modes of providing feedback are
effective.Praise, punishment, and
rewards contributed to the smallest effect on achievement.

A study evaluating survey responses of over 340 pharmacy students in
the United Kingdom on their perceptions of feedback from faculty showed that
98% of students agreed that receiving feedback was an important part of their
degree program and 80% of students agreed that feedback from faculty improved
their performance.3Not
surprisingly, less than 33% of the students agreed that they were satisfied
with the feedback they received.Inconsistencies
in providing feedback, the quantity, quality, and timing were common reasons
cited by students.Feedback given at the
end of a module was viewed as the least useful.

Balance between
positive and negative feedback

“Negative feedback isn’t always bad and positive
feedback isn’t always good. Too often,
they say, we forget the purpose of feedback.
It’s not to make people feel better, it’s to help them do better”

- A. Tugent, New York Times

Studies have shown that learners that truly desire to improve their
skills want constructive feedback and view the comments as opportunities for
improvement and growth.People learning
a new task prefer positive reinforcement to boost their confidence.4 Yet
some instructors struggle to give what some would perceive as “negative”
feedback.The term “constructive
feedback” is perhaps better nomenclature.Constructive feedback includes remarks that are productive, useful,
redirecting, and motivational, not destructive.This does not mean the learner should only receive praise.

Example of feedback
techniques & Strategies(4-6)

One common method of providing feedback is the Feedback Sandwich.4This technique provides the so-called negative feedback between two
positive comments.This strategy has
received much criticism for being ineffective because many learners will only
hear the praise, thus undermining the intent. Authors
of The Power of Feedback argue that focusing the feedback on the task
and self-regulation are the most powerful modes of feedback, whereas feedback
about the self as a person is the least effective. 2In the One Minute Preceptor technique, the preceptor probes the learner
for supporting evidence after the learner has articulated a
recommendation.The preceptor then
reinforces actions done well and lastly makes recommendations for improvement.5Another common way of providing feedback is
the W3 in which the preceptor allows
the learner to self-reflect utilizing three questions:what worked well, what did not work well,
what we can do differently next time.There are other strategies such as 360
degrees that attempts to elicit feedback from various sources such as other
learners, colleagues, as well as supervisors.

I like the W3 method but sometimes learners are their
own worst critic; therefore, I like utilizing the W3 informally. I like
constructive feedback from the instructor about a specific task in real time
(e.g. while I’m performing the task or immediately afterward).As a learner, the worst experience is not
receiving any feedback until the end of the learning experience and realizing
you weren’t meeting expectations.It is
human nature to assume if there is no feedback that everything must be
fine.At the very least, feedback
sessions should be held formally at the middle and end … but informal feedback
should be given as much as possible.

Effective feedback
is essential for the learner’s growth and professional develop.With practice, the instructor will develop
his/her own strategy to effectively deliver motivational and useful feedback to
learners of all levels.Effective
feedback is FAST:frequent, accurate, specific, and timely. If you are going to make a feedback sandwich,
make it a “meaty” one.

1 comment:

Monique, your blog is extremely informative about the feedback process both as a budding preceptor giving feedback and resident, receiving feedback. Many questions arose for me as I read through your blog. I should point out first, I am also a PGY-1 resident in a teaching certificate program, so reading where another resident stands, “in similar shoes” is quite interesting to me. The first statistic that caught my eye was “A subgroup analysis of studies evaluating feedback observed an average effect of 50% greater than the effect than schooling itself,” “feedback is at least 50% more powerful at influencing the learners’ achievement,” and praise, punishment, and rewards contributed to the smallest effect on achievement.” While reading your blog I had a very difficult time understanding your point of view, and how these statistics and knowledge have affected you as both a resident and a preceptor. So my first question is, how do those quotes above affect your precepting, and how has it affected you as a learner?

The next part I was interested in was where you stated that, “98% of students agreed that receiving feedback was an important part of their degree program and 80% of students agreed that feedback from faculty improved their performance”, but “less than 33% of the students agreed that they were satisfied with the feedback they received” as well as inconsistencies relating to the primary reason of dissatisfaction. These are very strong statistics. How has this affected you in your teaching style as a preceptor? Do you give more consistent feedback to your students? Have you discussed these with your preceptors? Or do you preceptors give you feedback, which is consistent? How do you prevent inconsistencies as a preceptor?

The quote from the NY times was spot on when referring to feedback as “we forget the purpose of feedback. It’s not to make people feel better; it’s to help them do better.” I believe this is a very important concept. How has this affected your teaching style? Do you incorporate this into your teaching? Do you keep it as a reminder about the purpose of feedback?

You stated from a source that people learning a new task prefer positive reinforcement to boost their confidence. Is this something you practice, something you have observed, and/or something you see as necessary?

You discuss many different feedback techniques as well as comment that “you like” the W3 method. Why do you specifically like this method? Has it been helpful to you as a resident? Has it been useful to you as a preceptor?

You also discussed receiving formal and informal feedback and at the very least formal feedback should be given two times. Should formal feedback always be given? You mention informal feedback should be given as often as possible. Is there such as concept as too much feedback? How has this affected you as a student, resident, and preceptor?

Lastly, you mention that an instructor “will develop his/her own strategy to effectively deliver motivation and useful feedback to learners of all levels.” How has your experience as a student, resident, and now preceptor molded your strategies to deliver motivation and useful feedback?

Thank you for the opportunity to read your blog on providing effective feedback. It has been very informational. I am interested, though, to read in addition, more about how your experience reflects the literature.

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